Provider Demographics
NPI:1871561589
Name:CALKIN, JACQUELINE MARIE (MD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MARIE
Last Name:CALKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 FAIR OAKS BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-4936
Mailing Address - Country:US
Mailing Address - Phone:916-646-3376
Mailing Address - Fax:916-646-3336
Practice Address - Street 1:2625 FAIR OAKS BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-4936
Practice Address - Country:US
Practice Address - Phone:916-646-3376
Practice Address - Fax:916-646-3336
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG081375207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG081375OtherSTATE LICENSE
CAGR0098940Medicaid
CATAX ID NUMBEROther432054849
CABC9858183OtherDEA NUMBER
CAG081375OtherSTATE LICENSE
CAGR0098940Medicaid